Constipation, Age 12 and Older

Topic Overview

Constipation occurs when stools are difficult to pass. Some people are overly concerned with the frequency of their bowel movements, because they have been taught that a healthy person has a bowel movement every day. This is not true. Most people pass stools anywhere from 3 times a day to 3 times a week. If your stools are soft and pass easily, you are not constipated.

Constipation is present if you have 2 or fewer bowel movements each week or you do not take laxatives and have 2 or more of the following problems at least 25% of the time:

Straining

Feeling that you do not completely empty your bowels

Hard stools, or stools that look like pellets

A feeling of being blocked up

You can't pass stools unless you put a finger in your rectum or use manual pressure to pass a stool.

Constipation may occur with cramping and pain in the rectum caused by the strain of trying to pass hard, dry stools. You may have some bloating and nausea. You may also have small amounts of bright red blood on the stool or on the toilet tissue, caused by bleedinghemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the anus. This should stop when the constipation is controlled.

Constipation can mean the slow movement of stool through the intestines or problems releasing a stool.

Slow transit constipation

Lack of fiber is a common cause of constipation. Other causes include:

Outlet delay constipation

Constipation is sometimes caused by poor muscle tone in the pelvic area (outlet delay). Excessive straining, needing manual pressure on the vaginal wall, or feelings of incomplete emptying may be a symptom of this type of constipation. Outlet delay constipation is caused by:

Delaying bowel movements because of convenience issues or because having a bowel movement causes pain.

Constipation is more common in people older than 65. People in this age group are more likely to have poor dietary habits and increased medicine use. Older adults also often have decreased muscular activity of the intestinal tract, which increases the time it takes for stool to move through the intestines. Physical problems, such as arthritis, may make sitting on the toilet uncomfortable or painful.

Women report problems with constipation more often than men.

If a stool becomes lodged in the rectum (impacted), mucus and fluid may leak out around the stool, sometimes leading to leakage of fecal material (fecal incontinence). You may experience this as constipation alternating with episodes of diarrhea.

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